Biomedical Science and Research Journals | Sphenopalatine Block for Treatment of Migraine Headache
Sphenopalatine Block for Treatment of Migraine Headache
Migraine is a common headache and a leading cause of disability
worldwide [1]. Chronic migraine (CM) burdens patients due to
the headache and debilitating associated symptoms and through
disability high economic costs. CM patients meet diagnostic criteria
and have a minimum of headaches and symptoms 8 days a month
or headaches on 15 days a month. A complete, detailed history and
an in-depth physical examination with the emphasis on neurologic
aspects is required in order to differentiate CM from other causes of
headache. If indicated, other diagnostic tests may be required [2]. A
multifaceted approach is used to eliminate risk factors and headache
triggers. Prophylaxis and abortive approaches can be applied.
Use of pharmacologic agents for the acute/chronic treatment of
migraine may be limited by adverse side effects, variability if effect
and efficacy, or contraindications, allergies or untoward drug -drug
interactions. These factors contribute to chronicity of the headache
and medication overuse headache [3].
Historically, we have considered migraine as a self-limited pain
disorder that is episodic. More recently however, CM has become
an end stage disorder of episodic migraine (EM). The International
Headache Society suggests that CM is a complication of EM [4-6].
Indeed, other current evidence indicates that migraine may be a
chronic progressive disorder characterized by escalating frequency
of headache attacks, often termed transformed migraine. Munakata
et al. [7] reported that transformed migraine patients missed much
more work or school time. Productivity was significantly reduced.
Average per-person annual total costs were 4.4-fold greater for
those with transformed migraine ($7750) versus those with EM
($1757). Transformed migraine extracts a significant economic toll.
Approximately 15% of the world population is affected by
migraine. Incidence varies by sex, age, ethnic background and
geographic area. It is more common in women and reported to
be disabling in 2% of the general population [2,8-13]. In the US,
the National Foundation estimates that nearly 12 percent of the
population experience migraine headaches. This means that nearly
40 million people in the United States have migraines. Women are
about three times more likely than men to experience migraines.
Migraine is a common disabling brain disorder that affects one in
seven US citizens annually. The burden of migraine is substantial,
both in economic terms and for individual patients and their close
family members.
Migraines are a significant source of both medical costs and lost
productivity. It has been estimated that they are the most expensive
neurological disorder in the European Community, costing more
than €27 billion per year [14-7]. In the United States direct costs
have been estimated at $17 to 19.6 billion while indirect costs are
estimated at another $15 billion.
It is thought that as many as 20% of those with CM and one
in 8 of with high headache frequency are employable but are not
gainfully so [18]. CM imposes significant burdens. There may be
physical, emotional, occupational, academic, social, leisure, and
family systems placed on these patients. Societal burdens include
those direct and indirect costs which must be paid by society
through costs passed on to companies and their customers as well
as health care systems and taxpayers [19].
This article provides a brief view of acute and chronic migraine
treatment, using sphenopalatine (SPG) block with local anesthetics
drugs only. For full anatomic details and methods, please see the
reviews [20,25].
For over a hundred years, the sphenopalatine ganglion
(SPG) has been utilized to treat a wide variety of pain disorders.
Post-ganglionic parasympathetic, sympathetic neurons and the
somatic sensory efferent nerves can all be blocked by the SPG
interventions. Interventions include block with local anesthetics
and neural destructive agents, radiofrequency or surgical ablation,
and neurostimulation [20,21]. Painful conditions treated included:
headache of various etiologies, trigeminal neuralgia, oral/facial
pain due to cancer, tension headache in labor and post-dural
puncture headache (PDPH), herpetic neuralgia of the eye and
complex regional pain syndrome I and II of other body areas as well
as effective pain relief in various other pain syndromes including
sphenopalatine neuralgia, atypical facial pain, muscle pain,
vasomotor rhinitis and eye disorders.
Trials have shown that these pain disorders can be managed
effectively with sphenopalatine ganglion blockade (SPGB). The SPG
block with local anesthetics is a safe, easy to administer and costeffective
method to manage acute, chronic and breakthrough pain
and provides immediate relief and minimal adverse side effects
[22-25]. SPG block can be performed following a simple protocol by
physicians, nurse practitioners and PAs in various sites such as the
office, clinic and ER department.
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